{"doi":"10.1093/jnci/djad068","title":"Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer","abstract":"BACKGROUND: Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise. METHODS: We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis. RESULTS: Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (Ptrend < .001), respectively, with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month). CONCLUSIONS: Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.","journal":"JNCI Journal of the National Cancer Institute","year":2023,"id":318054,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":69,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.965,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":621468,"name":"Ebunoluwa Otegbeye","orcid":"0000-0001-5403-3615","position":1,"is_corresponding":false},{"id":448927,"name":"Xiaoyu Zong","orcid":"0000-0001-5646-710X","position":2,"is_corresponding":false},{"id":242792,"name":"Joshua Demb","orcid":"0000-0002-3338-1730","position":3,"is_corresponding":false},{"id":489803,"name":"Katelin B. Nickel","orcid":"0000-0003-4116-512X","position":4,"is_corresponding":false},{"id":385409,"name":"Margaret A. Olsen","orcid":"0000-0001-7070-9320","position":5,"is_corresponding":false},{"id":344464,"name":"Matthew G. Mutch","orcid":"0000-0001-5368-3907","position":6,"is_corresponding":false},{"id":1024570,"name":"Nicholas Davidson","orcid":"0000-0003-2375-8116","position":7,"is_corresponding":false},{"id":1024571,"name":"Samir Gupta","orcid":"0000-0002-4799-2348","position":8,"is_corresponding":false},{"id":261915,"name":"Yin Cao","orcid":"0000-0001-9835-7662","position":9,"is_corresponding":false},{"id":812558,"name":"Cassandra Fritz","orcid":"0000-0002-6485-7471","position":0,"is_corresponding":true}],"reference_count":48,"raw_metadata":null,"created_at":"2026-07-19T01:06:55.884740Z","pmid":"37138415","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}